Sicko USA, 2007
directed by Michael Moore
Finally, the Health Care Bill has passed. Amidst the violent Republican backlash—the death threats and fake anthrax scares—I decided to revisit Michael Moore’s documentary on the U.S. health care system, Sicko (2007). In Sicko, Moore explores the failings of the national health maintenance organization (H.M.O.) system of health care—where insurance companies, in pursuit of profit, are legally allowed to deny coverage for preexisting conditions or medical procedures deemed “experimental.” He takes us on a journey through universal health care systems in countries like Cuba, France, England, and Canada, effectively comparing them to a defunct American system. While the film does not sufficiently include critique of single-payer systems, it clearly articulates the widely accepted view that American health care is broken. In fact, Michael Moore is not the only one who has been vocal in his critique of the U.S. health care system. The health care debate predates the presidential tenures of both Barack Obama and Bill Clinton. So now that Obama has signed the bill into law, is Sicko still relevant?
The fight for universal health care in the United States actually goes back nearly 100 years when, in 1912, Theodore Roosevelt used it as a presidential campaign platform. At that time, the Germans were the only country with national compulsory sickness insurance, having established it nearly thirty years prior (1883). Yet the U.S. was a country on the brink of entering World War I, and it was certainly not going to adopt the health care system of its German enemies. In his book, The Social Transformation of American Medicine (Basic, 1982), sociologist Paul Starr argues that at the time, the U.S. was a country with a decentralized government based on principles of classical liberalism—conditions anathema to stronger social welfare programs.1 Needless to say, Roosevelt lost the election to Woodrow Wilson.
Meanwhile, Norway had established its national health insurance plan in 1909, Serbia in 1910, and Britain in 1911. The year Roosevelt lost the election, a national health plan emerged in Russia, and a year later, the Netherlands followed suit. Yet, it wasn’t until 1948 when Britain established its National Health Service (N.H.S.), effectively providing universal health care through a single-payer system, similar to the public option in the recent health care debate in the United States, which would have allowed for a government-run health insurance agency. In 1934, Franklin Roosevelt had tried to fit a national health insurance plan into the New Deal, but doctors vehemently lobbied against the idea. According to The New York Times, the American Medical Association was afraid that a universal health plan would “increase bureaucracy, limit physician freedom, and interfere with the doctor-patient relationship.”2 Sound familiar? Similar arguments are still echoed by American doctors. Michael Moore addresses this argument by speaking with a British doctor who works in an N.H.S. hospital. The physician emphatically explains how happy and, moreover, financially secure, he is working within a government-run health care system.
Throughout history we would see the same patterns of discord. John Kennedy tried to introduce a plan in 1962 that, due to heavy lobbying from the medical industry, eventually failed to pass through Congress. Three years later, Lyndon Johnson was finally able to pass Medicare and Medicaid, providing government funded health care for citizens over the age of sixty-five, as well as the poor, blind, and disabled. Meanwhile, the cost of health care began to rise, limiting access to quality care for an increasing number of Americans. When Nixon took office, it became evident that something had to be done. In another article from The New York Times, Harold M. Schmeck Jr. cited “rising costs and shortages of manpower” as “two of the big initial headaches for the Nixon Administration in the fields of health and medical science.”3 The article quotes a final report by the National Advisory Commission on Health Manpower that called for an immediate solution to the rising cost of care.
It was yet another defining moment in the history of health care in the United States. Just as we needed it most, in 1971, two familiar politicians came forward with competing health plans. Senator Edward Kennedy offered the solution of a universal single-payer health care plan. It was a fight that he would wage for the rest of his life. Unfortunately, Nixon’s idea of creating private Health Maintenance Organizations, also known as H.M.O.’s, trumped the proposed single-payer system. Moore presents us with the audiotape of Nixon discussing the benefits of an H.M.O. system. Nixon, in a conversation with an advisor states, “You know I’m not too keen on any of these damn medical programs.” His advisor assures him of the benefits of a private alternative: “All the incentives are toward less medical care, because the less care they give them, the more money they make.” That seemed to have won Nixon over—in December 1973, he signed the Health Maintenance Organization Act into law.
This is effectively the premise for Michael Moore’s Sicko. While he opens the documentary with stories of Americans without health care, he purposely states that the film is not about this population but rather, it is a film about our broken H.M.O. system—about those who do have health care but who are refused coverage in the name of profit. Perhaps the most controversial story of the film is that of a group of 9/11 rescue workers suffering from illnesses directly related to their work at Ground Zero. Having been refused care by their respective H.M.O.’s, Moore and friends pile into a boat and sail to Guantanamo Bay, Cuba, where inmates of the prison receive exceptional government health care. Of course, upon arrival, the U.S. government does not allow them to enter. Instead, the group sails to the part of the island under Cuban jurisdiction, where they receive much needed medical attention—all free of charge.
Besides Cuba and England, Moore also takes us on a health care tour of both Canada and France. Many criticized Moore for an imbalanced portrayal of these systems. According to an article by Fred Lucas in Cybercast News Services (CNS)—formerly known as the Conservative News Service—criticisms of single-payer health care, such as that found in Canada and the UK, include claims of denial or delay of imperative procedures and long wait times in emergency rooms.4 Ironically, these are complaints that are also familiar to many Americans. Moreover, the World Health Organization’s (W.H.O.) World Health Report (2000) assesses the efficiency of the world’s health systems. Out of 191 countries surveyed, the report shows that while the U.S. spends a higher portion of its gross domestic product than any other country in the study, it ranked only 37th in efficiency overall. France ranked first, England placed 18th, and Canada came in at 30th, well ahead of the United States. So, despite Moore’s omission of common critiques of European and Canadian health care systems, the W.H.O. still deems the American system as insufficient in comparison. In fact, the U.S. ranked second-to-last amongst all other developed countries. Other examples of more efficient health care systems include those of Costa Rica, Chile, Morocco, and Colombia.5
Nevertheless, now that Obama and the Democratic-controlled congress have passed the health care bill, have we ameliorated the system? Not quite. Some would argue that, since the public option is absent, the “Patient Protection and Affordable Care Act” and the “Health Care and Education Reconciliation Act of 2010” do not go far enough. Instead, the new law stipulates the creation of “American Health Benefit Exchanges,” which will go into effect in 2014. All U.S. citizens and legal immigrants will apparently have access to an insurance marketplace, where several private insurance companies, as well as some non-profit and member-run health insurance cooperatives, will compete for your business. As the bill requires all individuals to buy health insurance, the government will provide premium and cost-sharing subsidies for those in need.6 Patients’ use of federal subsidies to pay for private health plans covering abortion became a contentious issue, one that anti-abortion Democrats almost used to prevent the passing of the bill. Obama, in turn, angered his pro-choice constituency by responding with an executive order banning federally funded abortion.
How does this affect people who are denied health coverage due to preexisting conditions or “experimental” treatments, such as those who shared their stories in Sicko? The act also enforces new regulations on health insurance companies, effectively preventing health insurers from denying coverage to people for any reason. New stipulations will also require health plans to provide comprehensive coverage, including a minimum set of services. A rule that bans denied coverage due to preexisting conditions takes effect immediately.
Only time will tell whether this moment in the history of U.S. health care reform will make a dramatic impact on our lives. As for the relevance of Sicko, it still stands as a reminder of the vital necessity of new health care legislation. As someone who has spent many hours on the telephone with insurance companies contesting hundreds of dollars of extraneous charges—combating the general bureaucracy that is the U.S. health care system—I am anxious and hopeful for positive change. For someone that has seen this broken system up close, it is hard to comprehend the resistance to its amelioration and, moreover, the violent reaction to the passing of legislation that does not even include a public option. While many Americans criticize Michael Moore for touting the French two-tier health system—one that is ranked number one by the World Health Organization—or single payer systems such as those of Canada and the UK—also ranked higher than the United States—the U.S. system remains broken. I am curious to see the effects of the new legislation, most of which will take effect in four years from now. In the meantime, I suggest watching Sicko—just don’t forget your box of tissues. While you’re at it, it couldn’t hurt to vote in the midterm elections for those representatives who support health care reform. Until then, stay well.
1. Paul Starr. The Social Transformation of American Medicine (New York: Basic Books, 1982).
2. Elisabeth Goodridge and Sarah Arnquist. “A History of Overhauling Health Care,” The New York Times. http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEAL…. Retrieved March 25, 2010.
3. 4Harold M. Schmeck Jr. “Need to Reshape Health Care is Seen,” The New York Times (January 5, 1969). Online: http://www.nytimes.com/packages/flash/health/HEALTHCARE_TIMELINE/1969_r….
4. Fred Lucas. “White House Stands by Obama’s Claim that Single-Payer Health Care Works in Other Countries—It’s Just Not Sure Which Countries Obama Meant,” CNS News (June 18, 2009). Retrieved April 25, 2010: http://www.cnsnews.com/public/content/article.aspx?RsrcID=49743.
5. World Health Organization. The World Health Report 2000 (Geneva, Switzerland: 2000). Online: http://www.who.int/whr/2000/en/.
6. The Henry J. Kaiser Foundation. “Summary of Coverage Provisions in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010,” Focus on Health Reform (April 5, 2010). Retrieved April 25, 2010: http://www.kff.org/healthreform/upload/8023-R.pdf.